Skip to main content

Conservative Treatment of Pediatric ACL Injury

  • Chapter
  • First Online:
Controversies in the Technical Aspects of ACL Reconstruction

Abstract

The participation of children and adolescents in organized sports is increasingly popular and widespread, with the public and government focus on the health benefits from regular physical activities being a contributing factor to this development. There is epidemiological evidence that better levels of physical fitness at young age decrease future mortality and morbidity, but there is also a concern that participation in sports exposes children and adolescents to higher risks of musculoskeletal injuries which may influence long-term health negatively. Injury incidence and severity are high in some child and youth sports, and most injuries occur in the lower extremities. Throughout the last two decades, there have been an increasing number of reports on ACL injuries among skeletally immature individuals. This chapter outlines the potential of rehabilitation as the primary treatment until a final decision is made on the treatment when the patient has reached full skeletal maturity.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Alentorn-Geli E, Myer GD, Silvers HJ, Samitier G, Romero D, Lazaro-Haro C, Cugat R (2009) Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: mechanisms of injury and underlying risk factors. Knee Surg Sports Traumatol Arthrosc 17(7):705–729

    Article  PubMed  Google Scholar 

  2. Anderson AF, Anderson CN (2015) Correlation of meniscal and articular cartilage injuries in children and adolescents with timing of anterior cruciate ligament reconstruction. Am J Sports Med 43(2):275–281

    Article  PubMed  Google Scholar 

  3. Barber-Westin SD, Noyes FR (2011) Objective criteria for return to athletics after anterior cruciate ligament reconstruction and subsequent reinjury rates: a systematic review. Phys Sportsmed 39(3):100–110

    Article  PubMed  Google Scholar 

  4. Bleakley CM, Glasgow P, MacAuley DC (2012) PRICE needs updating, should we call the POLICE? Br J Sports Med 46(4):220–221

    Article  CAS  PubMed  Google Scholar 

  5. Calvo R, Figueroa D, Gili F, Vaisman A, Mococain P, Espinosa M, Leon A, Arellano S (2015) Transphyseal anterior cruciate ligament reconstruction in patients with open physes: 10-year follow-up study. Am J Sports Med 43(2):289–294

    Article  PubMed  Google Scholar 

  6. Demange MK, Camanho GL (2014) Nonanatomic anterior cruciate ligament reconstruction with double-stranded semitendinosus grafts in children with open physes: minimum 15-year follow-up. Am J Sports Med 42(12):2926–2932

    Article  PubMed  Google Scholar 

  7. Faber M, Andersen MH, Sevel C, Thorborg K, Bandholm T, Rathleff M (2015) The majority are not performing home-exercises correctly two weeks after their initial instruction-an assessor-blinded study. PeerJ 3:e1102

    Article  PubMed  PubMed Central  Google Scholar 

  8. Fabricant PD, Jones KJ, Delos D, Cordasco FA, Marx RG, Pearle AD, Warren RF, Green DW (2013) Reconstruction of the anterior cruciate ligament in the skeletally immature athlete: a review of current concepts: AAOS exhibit selection. J Bone Joint Surg Am 95(5):e28

    Article  PubMed  Google Scholar 

  9. Faigenbaum AD, Kraemer WJ, Blimkie CJ, Jeffreys I, Micheli LJ, Nitka M, Rowland TW (2009) Youth resistance training: updated position statement paper from the national strength and conditioning association. J Strength Cond Res 23(5 Suppl):S60–S79

    Article  PubMed  Google Scholar 

  10. Frosch KH, Stengel D, Brodhun T, Stietencron I, Holsten D, Jung C, Reister D, Voigt C, Niemeyer P, Maier M, Hertel P, Jagodzinski M, Lill H (2010) Outcomes and risks of operative treatment of rupture of the anterior cruciate ligament in children and adolescents. Arthroscopy 26(11):1539–1550

    Article  PubMed  Google Scholar 

  11. Funahashi KM, Moksnes H, Maletis GB, Csintalan RP, Inacio MC, Funahashi TT (2014) Anterior cruciate ligament injuries in adolescents with open physis: effect of recurrent injury and surgical delay on meniscal and cartilage injuries. Am J Sports Med 42(5):1068–1073

    Article  PubMed  Google Scholar 

  12. Goddard M, Bowman N, Salmon LJ, Waller A, Roe JP, Pinczewski LA (2013) Endoscopic anterior cruciate ligament reconstruction in children using living donor hamstring tendon allografts. Am J Sports Med 41(3):567–574

    Article  PubMed  Google Scholar 

  13. Grindem H, Granan LP, Risberg MA, Engebretsen L, Snyder-Mackler L, Eitzen I (2015) How does a combined preoperative and postoperative rehabilitation programme influence the outcome of ACL reconstruction 2 years after surgery? A comparison between patients in the Delaware-Oslo ACL Cohort and the Norwegian National Knee Ligament Registry. Br J Sports Med 49(6):385–389

    Article  CAS  PubMed  Google Scholar 

  14. Heckmann TP, Barber-Westin SD, Noyes FR (2006) Meniscal repair and transplantation: indications, techniques, rehabilitation, and clinical outcome. J Orthop Sports Phys Ther 36(10):795–814

    Article  PubMed  Google Scholar 

  15. Hewett TE, Ford KR, Myer GD (2006) Anterior cruciate ligament injuries in female athletes: part 2, a meta-analysis of neuromuscular interventions aimed at injury prevention. Am J Sports Med 34(3):490–498

    Article  PubMed  Google Scholar 

  16. Johnsen MB, Eitzen I, Moksnes H, Risberg MA (2015) Inter- and intrarater reliability of four single-legged hop tests and isokinetic muscle torque measurements in children. Knee Surg Sports Traumatol Arthrosc 23(7):1907–1916

    Article  PubMed  Google Scholar 

  17. Kaeding CC, Flanigan D, Donaldson C (2010) Surgical techniques and outcomes after anterior cruciate ligament reconstruction in preadolescent patients. Arthroscopy 26(11):1530–1538

    Article  PubMed  Google Scholar 

  18. Kim SJ, Shim DW, Park KW (2012) Functional outcome of transphyseal reconstruction of the anterior cruciate ligament in skeletally immature patients. Knee Surg Relat Res 24(3):173–179

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kruse LM, Gray BL, Wright RW (2011) Anterior cruciate ligament reconstruction rehabilitation in the pediatric population. Clin Sports Med 30(4):817–824

    Article  PubMed  Google Scholar 

  20. Kumar S, Ahearne D, Hunt DM (2013) Transphyseal anterior cruciate ligament reconstruction in the skeletally immature: follow-up to a minimum of sixteen years of age. J Bone Joint Surg Am 95(1):e1

    Article  PubMed  Google Scholar 

  21. Lynch AD, Logerstedt DS, Grindem H, Eitzen I, Hicks GE, Axe MJ, Engebretsen L, Risberg MA, Snyder-Mackler L (2015) Consensus criteria for defining ‘successful outcome’ after ACL injury and reconstruction: a Delaware-Oslo ACL cohort investigation. Br J Sports Med 49(5):335–342

    Article  PubMed  Google Scholar 

  22. McKay CD, Steffen K, Romiti M, Finch CF, Emery CA (2014) The effect of coach and player injury knowledge, attitudes and beliefs on adherence to the FIFA 11+ programme in female youth soccer. Br J Sports Med 48(17):1281–1286

    Article  PubMed  Google Scholar 

  23. Mizuta H, Kubota K, Shiraishi M, Otsuka Y, Nagamoto N, Takagi K (1995) The conservative treatment of complete tears of the anterior cruciate ligament in skeletally immature patients. J Bone Joint Surg Br 77(6):890–894

    CAS  PubMed  Google Scholar 

  24. Mohtadi N, Grant J (2006) Managing anterior cruciate ligament deficiency in the skeletally immature individual: a systematic review of the literature. Clin J Sport Med 16(6):457–464

    Article  PubMed  Google Scholar 

  25. Moksnes H, Engebretsen L (2015) It takes more than timing: letter to the editor. Am J Sports Med 43(6):NP14–NP15

    Article  PubMed  Google Scholar 

  26. Moksnes H, Engebretsen L, Eitzen I, Risberg MA (2013) Functional outcomes following a non-operative treatment algorithm for anterior cruciate ligament injuries in skeletally immature children 12 years and younger. A prospective cohort with 2 years follow-up. Br J Sports Med 47(8):488–494

    Article  PubMed  Google Scholar 

  27. Moksnes H, Engebretsen L, Risberg MA (2008) Performance-based functional outcome for children 12 years or younger following anterior cruciate ligament injury: a two to nine-year follow-up study. Knee Surg Sports Traumatol Arthrosc 16(3):214–223

    Article  PubMed  Google Scholar 

  28. Moksnes H, Engebretsen L, Risberg MA (2012) The current evidence for treatment of ACL injuries in children is low: a systematic review. J Bone Joint Surg Am 94(12):1112–1119

    Article  PubMed  Google Scholar 

  29. Moksnes H, Engebretsen L, Risberg MA (2012) Management of anterior cruciate ligament injuries in skeletally immature individuals. J Orthop Sports Phys Ther 42(3):172–183

    Article  PubMed  Google Scholar 

  30. Moksnes H, Engebretsen L, Risberg MA (2013) Prevalence and incidence of new meniscus and cartilage injuries after a nonoperative treatment algorithm for ACL tears in skeletally immature children: a prospective MRI study. Am J Sports Med 41(8):1771–1779

    Article  PubMed  Google Scholar 

  31. Moksnes H, Engebretsen L, Seil R (2016) The ESSKA paediatric anterior cruciate ligament monitoring initiative. Knee Surg Sports Traumatol Arthrosc 24:680–687

    Article  PubMed  Google Scholar 

  32. Olsen OE, Myklebust G, Engebretsen L, Holme I, Bahr R (2005) Exercises to prevent lower limb injuries in youth sports: cluster randomised controlled trial. BMJ 330(7489):449

    Article  PubMed  PubMed Central  Google Scholar 

  33. Reider B (2015) A matter of timing. Am J Sports Med 43(2):273–274

    Article  PubMed  Google Scholar 

  34. Renstrom P, Ljungqvist A, Arendt E, Beynnon B, Fukubayashi T, Garrett W, Georgoulis T, Hewett TE, Johnson R, Krosshaug T, Mandelbaum B, Micheli L, Myklebust G, Roos E, Roos H, Schamasch P, Shultz S, Werner S, Wojtys E, Engebretsen L (2008) Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement. Br J Sports Med 42(6):394–412

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Soligard T, Myklebust G, Steffen K, Holme I, Silvers H, Bizzini M, Junge A, Dvorak J, Bahr R, Andersen TE (2008) Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. BMJ 337:a2469

    Article  PubMed  PubMed Central  Google Scholar 

  36. Steffen K, Emery CA, Romiti M, Kang J, Bizzini M, Dvorak J, Finch CF, Meeuwisse WH (2013) High adherence to a neuromuscular injury prevention programme (FIFA 11+) improves functional balance and reduces injury risk in Canadian youth female football players: a cluster randomised trial. Br J Sports Med 47(12):794–802

    Article  PubMed  Google Scholar 

  37. Woods GW (2004) Delayed anterior cruciate ligament reconstruction in adolescents with open physes. Am J Sports Med 32(1):201–210

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lars Engebretsen MD, PhD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 ISAKOS

About this chapter

Cite this chapter

Engebretsen, L., Moksnes, H. (2017). Conservative Treatment of Pediatric ACL Injury. In: Nakamura, N., Zaffagnini, S., Marx, R., Musahl, V. (eds) Controversies in the Technical Aspects of ACL Reconstruction. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-52742-9_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-52742-9_7

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-52740-5

  • Online ISBN: 978-3-662-52742-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics